Chapter 23: Introduction to Psychopathology

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Hello everyone and welcome back to the show.

We are so glad to have you with us today for another deep dive.

It is great to be here.

Today is, it's a special one.

I feel like we're turning a corner.

We are.

We're standing at a threshold, really.

That's a good way to put it.

We are looking at chapter 23 of Psychiatric Nursing, the seventh edition.

And the title is Introduction to Psychopathology.

And threshold is absolutely the right word.

I mean, if you look at how the textbook is structured,

this chapter kicks off unit V.

Unit V, putting it all together.

Exactly.

That sounds pretty significant, doesn't it?

It does.

It sounds like, you know, we're finally getting to the good stuff.

That's what it is.

Up until this point, if you're a student, you've likely been wading through, you know, the history of nursing, legal concepts, all the different theories, therapeutic communication.

And the building blocks.

All the foundational building blocks.

But this chapter, this is the gateway.

This is where we stop talking in generalities and start looking at the actual disorders that patients face.

So the mission for us today is, I think, pretty clear.

We need to help bridge that gap

between simply caring for a patient and truly understanding what's going on with them.

And that distinction is just, it's vital.

The author, Norman Kiltner, he really opens the chapter with a bit of a challenge to the reader.

He talks about what he calls a paradigm shift.

I have to say, I loved the way this was written in the text.

It was almost sassy.

It was, a little bit, yeah.

He describes what he calls the old paradigm.

He says, and I'm quoting here,

caring teachers urged caring students to be more caring.

And then what does he write right after that?

Right there in the text, in parentheses, it just says yawn.

That yawn says so much, doesn't it?

It's not that he's dismissing the idea of caring.

We have to be really clear about that.

Absolutely not.

Caring is the foundation of all nursing.

But what he's saying is that the old way of teaching, where we just told nurses to be nice and hold hands,

it's boring.

And it's incomplete.

It's incomplete.

It's intellectually lazy, in a way.

It's just not enough.

So if that's the old paradigm, what is the new paradigm?

The new paradigm is this fundamental realization that caring is not enough.

You can be the kindest, most empathetic person in the world, but if you're standing in front of a patient who has schizophrenia,

your kindness alone isn't going to stabilize their neurochemistry.

Right.

The text says it explicitly.

Psychiatric nurses must understand

psychobiology and psychopharmacology.

So we are moving from, I guess, hearts to heart -sandy brains.

Precisely.

And the text uses a really, really powerful analogy here to drive this point home.

It compares what we do in psychiatric nursing to medical surgical nursing.

Okay, let's unpack that analogy.

Because I think for a student who might be more comfortable with IVs and wound care, this is what makes it click.

Think about a medsurg nurse on any floor.

A medsurg nurse cannot function, I mean, cannot do their job safely without a deep understanding of pathophysiology.

If you don't know how the pancreas works, you can't really treat diabetes effectively.

You're just, you're following orders blindly.

You have to understand the underlying pathology of the body.

And the argument here is that the exact same rule applies to us.

A psych nurse cannot function effectively without understanding psychopathology.

You need to understand the pathology of the mind.

You have to know why the neurons might be misfiring or why serotonin isn't binding correctly.

Without that, you're not really planning care.

No, you're just, as the text implies, you're just babysitting.

You're not intervening therapeutically.

So that's our setup.

That is why this chapter is so important.

We aren't just memorizing lists of symptoms.

We're learning the mechanics of the mind so we can actually help people heal.

Exactly.

Now, before we get into all the definitions in the DSM, we really need to understand the battlefield.

The text does a great job laying out the scope of the problem.

And the numbers are.

They're truly eye -opening.

The book cites a study by Reeves and colleagues from 2013.

Lay it on us.

What's the big number?

The big number is 25%.

One quarter.

One quarter, yes.

25 % of the entire U .S.

adult population is affected by mental disorders in any given year.

I just, I wanna pause on that for a second.

Let that sink in.

If you're listening to this and you're sitting in a lecture hall with, say, 100 other nursing students,

statistically, 25 of them are dealing with a diagnosable mental disorder right now.

Not at some point in their lifetime, but this year.

It just completely contextualizes the issue, doesn't it?

Yeah.

This is not a niche problem.

It's not something for those people over there.

No.

It's our neighbors, it's our colleagues, it's our families.

It's a massive, massive public health issue.

There's a little sidebar in the text.

I always love these.

It's called Norm's Notes.

And it felt a little more personal.

It did.

The author, Norman Keltner, he kinda takes a moment to reflect.

He points out that he's been in this field for a long time.

He's seen the older stats, as he calls them.

And he did not sound happy about the trend.

No, he sounded discouraged.

And he says so.

He points out that despite billions of dollars, billions with a B being spent on mental health research and treatment.

You'd think things would be getting better.

You would think.

But more people have mental disorders today than they did 30 years ago.

That is, that's so discouraging.

With all that money, all the new medications, you'd expect the numbers to be going down.

But they're going up.

And the text doesn't really speculate on why that is.

You know, is it better diagnosis?

Is it the stress of modern life?

Environmental factors?

Who knows?

But it acknowledges the reality.

The trend line is moving in the wrong direction.

Exactly.

Which again, just reinforces why we need smart, educated nurses.

We're losing ground in some ways.

And we need reinforcements on the front lines who actually understand psychopathology.

Okay, so let's get into the weeds of those numbers.

The chapter provides two really important tables.

Table 23 -1 and table 23 -2 that break down this landscape of mental illness for us.

Let's start with table 23 -1.

This one looks at the 12 -month prevalence.

Right, so this is just a snapshot of a single year.

So if we look at the hierarchy, the different categories of disorders, who is the king of the hill?

What is the most common issue people are facing?

It's anxiety disorders.

And not just by a little bit, by a pretty significant margin.

What's the number?

Overall, 18 .1 % of adults have an anxiety disorder.

18%, that's nearly one in five people.

That is huge.

It is.

And that category includes things like panic disorder,

generalized anxiety, social anxiety, phobias.

It's the most pervasive mental health challenge in the country.

Okay, so anxiety is number one.

What comes in second place?

After that, you have the mood disorders.

So this is where you'd find major depression and bipolar disorders.

And then third?

Third is impulse control disorders.

And fourth on that list.

And fourth is substance abuse disorders.

It's really interesting to see that hierarchy laid out.

I mean, anxiety and mood disorders are just, they're the big two that are really dominating the landscape.

Absolutely.

Now the text does mention specific disorders within those broader categories.

Yes, and this is important.

If you strip away the categories and just look at individual specific diagnoses, the two most common are major depression and phobias.

So as a nursing student, the takeaway is you are statistically almost guaranteed to encounter patients with depression or some kind of specific phobia.

Guaranteed.

And you're not just gonna see them on the psych ward.

You'll see them in the ER.

You'll see them on the cardiac unit in labor and delivery.

They're everywhere.

Now I wanna talk about the demographics in this table because there's a section on gender over -representation that I found really fascinating.

The data shows that mental illness doesn't affect men and women in exactly the same way.

It's true.

There are some very clear patterns when the table breaks it down.

Okay, let's start with the women.

Where do we see a female predominance?

Women show significantly higher rates for anxiety disorders in general, panic disorders specifically, and major depression.

So it seems like women might be more prone to what we could call internalizing disorders, the anxiety, the sadness.

That's a very fair assessment based on this data.

Panic attacks, for instance, are clearly listed as having a female predominance.

Specific phobias as well at seven to 9 % are also female predominant.

Okay, so now let's flip it.

Let's look at the men.

Where is the male predominance?

Men tend to dominate the statistics when it comes to substance use disorders.

Both alcohol use disorders and drug use disorders show a clear male predominance.

And what about some of the developmental issues mentioned?

The table also notes that autism spectrum disorders and ADHD in children are much, much more common in males.

It's an interesting pattern, isn't it?

Again, these are broad trends, but the women are anxious and depressed.

The men are using substances or showing more externalizing behavioral issues.

It's an important pattern for a nurse to recognize.

It helps with your assessment.

You know, if a male patient comes in, you might have a slightly higher index of suspicion for substance issues.

And if a female patient comes in, you might be a bit more tuned to looking for subtle signs of panic or depression.

Exactly, it's part of building that clinical picture.

But not everything is split down the middle by gender, right?

Are there any what we might call equal opportunity disorders?

Yes, and interestingly, they are some of the heavy hitters.

Schizophrenia shows equal representation between men and women.

That's surprising to me.

I feel like media often portrays it one way or another, but the actual data says it cuts right down the middle.

The data says it cuts right down the middle.

Bipolar eye disorder is also roughly equal, and the text also lists separation anxiety as being equally represented.

Fascinating.

So the underlying biology of something like schizophrenia doesn't seem to care about gender at all.

It appears not.

Okay, so that was table 23 -1, the 12 -month snapshot, but then table 23 -2 zooms out.

It looks at lifetime prevalence.

And as you would expect, the numbers go up.

Of course they do, because now we're not asking, do you have this disorder right now?

We're asking, have you ever in your life had this disorder?

But the real story in this lifetime data isn't just that the numbers are higher, it's this concept of comorbidity.

This is such a crucial concept for students to grasp.

Comorbidity basically means having two or more disorders in the same person at the same time.

And it's rarely just one thing, is it?

It is so rarely just one thing.

And the text gives a really powerful, almost shocking statistic here.

It says that 45 % of the population who has one disorder has a history of three or more comorbid disorders.

Wow, wait, let me just repeat that to make sure I heard it right.

If you have one diagnosed mental disorder, there is basically a coin flips chance that you actually have three or more of them.

That's what the data says.

So if you're treating a patient for alcoholism, there's a very, very high probability that they also have underlying depression and an anxiety disorder.

Or if you're treating someone for bipolar disorder, they might also have a substance abuse issue and a personality disorder on top of it.

It's a tangled web.

And that right there explains why just caring isn't enough.

You were dealing with a complex interlocking puzzle of different pathologies.

And then the text drops another bombshell.

It mentions a treatment gap.

What's the treatment gap?

It notes that most of these individuals, even the ones with multiple comorbid disorders, do not seek professional help.

They're out there just suffering in silence.

The text calls it a great reservoir of unmet mental health needs, which means the patients we actually see in the hospital, they're just the tip of the iceberg.

They're just the ones who, for whatever reason, finally made it through the door.

There is a vast ocean of pathology out there that never gets formally treated.

That's a heavy thought.

But it really does underscore the importance of what we do.

So, okay,

we've established the problem is huge, it's complex, it's layered.

Now, how do we actually define it?

The chapter moves into a section called defining psychopathology.

Right, and the author asks a very basic question.

How do you even begin to understand something as messy and complicated as the human mind?

And the answer is, you need standards.

You need a system.

The text lists three specific requirements for understanding psychopathology.

Let's walk through them.

Requirement number one.

Number one, knowledge should be organized.

You can't just have a random jumble of observations and symptoms.

You need a system, some kind of framework, to categorize what you're seeing.

Makes sense.

Requirement number two.

Number two, operational definition should be formed.

This is very scientific language.

It means we have to define exactly what we're talking about.

We can't just say he's acting crazy.

We have to define hallucination, delusion, mania, with extreme precision so that every single professional is using the same words to mean the same thing.

A common language.

And requirement number three.

And number three, criteria for diagnosis should be developed.

This is where the rubber meets the road.

We need a checklist.

We need to be able to say, if a patient meets criteria A, B, and C, then they have this disorder.

This allows for consistent, reliable diagnosis across different doctors, different hospitals, different states.

And this leads us directly to the book that contains all of those definitions and all of those criteria, the DSM.

The Diagnostic and Statistical Manual of Mental Disorders.

The Bible of Psychiatry, in many ways.

The text instances this as the official diagnostic manual used in the United States.

It's published by the American Psychiatric Association, or ABA.

And the version we're currently using, and the one students need to know, is the DSM -5, which came out in 2013.

The text gives a little bit of history here.

It notes that this is actually the seventh iteration, the seventh version, since the very first DSM was published way back in 1952.

It's incredible to think about how much has changed since 1952.

But the text also adds an important note of controversy.

Oh, what's that?

It says, and I'm quoting,

not all psychiatric professionals, including some at the National Institute of Mental Health and IMH, have endorsed this newest version.

So even the experts argue about the rule book.

Always.

Psychiatry is a constantly evolving field, but the text is very clear with the student.

Despite any controversy, this textbook follows the DSM -5 reasoning.

That is what you need to know for your exams and for your clinical practice.

Now, speaking of evolution, the text spends a good amount of time explaining a major shift from the old way of the DSM to the new way.

Specifically, this move away from a multi -axial system.

This is so important for students to understand because you will absolutely encounter older patient charts, or you might work with older clinicians who still think in terms of axes.

You need to know what they're talking about.

So let's do a quick history lesson.

The old version, the DSM -IVTR, used five axes.

Let's walk through them just so we understand what we left behind.

What was Axis this in?

Axis I was for the primary clinical disorders.

This was usually the main reason the person was seeking treatment or was admitted.

Things like schizophrenia, major depression, bipolar disorder, panic disorder.

You could think of it as the acute flare -up type of stuff.

Okay, and Axis II.

Axis II was reserved for personality disorders or developmental disorders.

This is where you would put things like borderline personality disorder, narcissistic personality disorder, or what used to be called mental retardation, which we now call intellectual disability.

So why were they separated out?

What was the thinking there?

The idea at the time was that Axis II disorders were more ingrained, more a part of the person's fundamental nature or personality structure, whereas Axis psychic disorders were seen more like illnesses that happened to the person.

Got it.

Okay, Axis III.

Axis III was for general medical conditions.

This is where you'd list the patient's diabetes, their cancer diagnosis, their thyroid issue, anything physical that might be impacting their mental state.

Axis IV.

Axis IV was for psychosocial and environmental problems.

This was the light stressors category.

Divorce, homelessness, job loss, fail in a class.

And finally, the famous Axis V.

Axis V was the GAF, the Global Assessment of Functioning Score.

It was a scale from zero to 100.

A score of 100 meant you were a super person functioning perfectly.

A score of 10 meant you were an imminent danger to yourself or others.

Okay, so that was the old way.

Five separate boxes to put information in.

What did the DSM -V do?

The DSM -V basically said, this is too artificial.

A person is a whole person.

It adopted a much more holistic approach.

It completely got rid of the first three Axis by collapsing them into one single category.

So now you just, you have a list of diagnosis.

Exactly.

You don't say, Axis I, depression, Axis II, borderline personality disorder.

You just write under diagnoses.

Major depressive disorder, borderline personality disorder, type two diabetes.

It puts them all on the same level, acknowledging that they all impact each other.

What happened to the environmental stuff?

The old Axis IV.

That's now captured by a specific coding system.

So you use what are called V codes or Z codes to note things like housing instability or relationship distress.

And the GAF score,

Axis V.

The text says it was removed entirely.

Why?

The book says it was gained too arbitrary or unspecific.

It just wasn't reliable.

One nurse might look at a patient and give them a GAF of 40.

And another nurse looking at the same patient on the same day might give them a 60.

It was way too subjective.

So what replaced it, if anything?

Well, the APA now recommends a different tool.

It's called the WHO days.

The WHO days.

Sounds like a band name from the 60s.

It does.

It stands for the World Health Organization Disability Assessment Schedule.

It's a much more detailed and rigorous tool for actually measuring how well a person is functioning across different life domains.

Okay, so that's the paperwork.

That's how we organize the information.

But what about the actual patient standing in front of us?

The chapter moves on to clinical assessment and etiology.

First, let's clarify some key terminology.

Signs versus symptoms.

This is a classic nursing distinction, but it is absolutely crucial in psych.

So what's the difference?

Signs are your objective assessment.

These are the behaviors that you, the nurse, can observe directly with your own senses.

Give me an example.

Pacing back and forth, crying, tremors in their hands,

pressured, rapid speech, a disheveled appearance.

These are all things you can see, hear, or even smell.

You don't need the patient to tell you they're happening.

And symptoms, then?

Symptoms are the subjective assessment.

These are the things the patient must report to you.

They are their internal experiences.

So examples would be, I feel suicidal.

I'm hearing voices telling me I'm a bad person.

I have this pit of anxiety in my stomach.

You cannot see anxiety directly.

You can see the signs of it, like sweating or trembling, but the internal feeling itself is a symptom they have to tell you about.

And the text says that knowing this distinction helps the nurse anticipate and plan appropriate interventions.

Right, it's about connecting the dots.

If you see the objective sign of a patient clenching and unclenching their fist, you anticipate the potential for aggression.

If you hear the subjective symptom of, I want to hurt myself, you anticipate suicide risk.

You need both to build a complete and accurate picture.

Okay, now we get to the big why question.

Etiology.

The text brings up the age -old nature versus nurture debate.

The eternal struggle in psychology.

The text describes two historical camps that people used to fall into.

Yes.

For a very long time, clinicians were kind of dug into one of two trenches.

Camp one was nature.

They believed that all mental disorders arise from organic, biologic, genetic causes.

It's a brain disease, plain and simple.

And camp two.

Camp two was nurture.

They believed that disorders arise from psychodynamics, from functional issues, environmental stressors, early life experiences, and trauma.

It's a psychological injury.

And for a long time, these two camps just fought about it.

They did.

But the text says, and this is so important, in recent years, most clinicians have come to recognize that both views provide valuable insights.

This is the modern synthesis.

Exactly.

And here is, I think, the most important sentence in the entire section.

It says,

research has suggested that some life experiences, nurture, change biology, nature.

That is.

That's a profound statement.

It is.

It means the entire debate is a false dichotomy.

It's not one or the other.

If you experience severe trauma as a child, that's nurture.

It can physically change the structure of your brain and the regulation of your stress hormones.

That's nature.

So the nurture becomes nature.

It just underscored that holistic view we were talking about with the DSM -5.

You can't separate the brain from the life that person has lived.

Absolutely.

And the text poses a critical thinking question right here.

It asks the student, why is it important to be open to both points of view?

And it also asks you to think about your own bias.

Yes, it says, what was your bias before you started nursing school?

Because we all have one.

Maybe you're really into science, so you want everything to be about neurotransmitters.

Or maybe you love psychology, so you want it all to be about childhood trauma.

And the text is warning you.

It's warning you.

Don't let your personal bias blind you to the whole patient.

You have to be prepared to treat the biology and the psychology.

They are two sides of the same coin.

Which is the absolute perfect transition to the next section, psychotherapeutic management.

This is the, okay, so what do we do about it,

part of the chapter?

This is all about practical application.

The text introduces psychotherapeutic management as a model that we're gonna see over and over again throughout the rest of the book.

And it says that while we'll learn specific interventions for specific disorders later on, there are some rules of the road that apply to all patients.

The eight golden rules.

I really wanna spend some time on these because they feel like they define the art of psychiatric nursing.

Let's do it.

They're foundational.

Okay, rule number one, provide support.

This one seems obvious, but it's the bedrock.

Support means providing both physical and emotional safety.

It means letting the patient know through your words and actions, I am here, I am steady, and I am not gonna let you fall apart.

Rule number two, strengthen patient's self -esteem.

And why is this so critical?

Because mental illness is profoundly demoralizing.

Patients often feel worthless, broken, ashamed, or guilty.

The nurse's job is to be a detective for their strengths, to find the small wins, and to help the patient see them too.

You are the mirror that shows them they are still a valuable human being.

I like that.

Rule number three, treat adult patients as adults.

This is a huge one.

It is so easy, especially when a patient is regressed or acting out or being very dependent, to slip into a parent mode, to start infantilizing them.

Now let's put on our little shoes and go to group.

The text warns against this so strongly.

Why is that so damaging?

Because it strips them of their dignity, and it actually reinforces the helpless behavior.

If you treat them like a capable adult, you are implicitly inviting them to act like a capable adult.

You hold that expectation for them.

Rule number four, prevent failure or embarrassment.

This ties right back into self -esteem.

Don't set the patient up for a task you know they can't handle at that moment.

If they're in the middle of a manic episode and can't focus more than 10 seconds, don't ask them to lead a complicated group game.

Because they'll fail.

They'll fail, they'll feel embarrassed, and they'll regress.

Your job is to be a therapeutic engineer.

You engineer situations where they can succeed, even in small ways.

So you have to anticipate their deficits and protect their dignity.

Exactly.

You modify the environment or the task to ensure they have a successful experience.

Success builds self -esteem.

That's rule number two.

Failure destroys it.

Okay, rule number five, treat patients as individuals.

Another one that sounds simple, but isn't.

Don't just treat the schizophrenic in room four.

Treat Mr.

Jones, who happens to have schizophrenia, and who also likes jazz music and misses his dog.

Stereotyping and labeling are the enemies of good therapeutic care.

Rule number six, provide reality testing.

This is absolutely crucial for patients experiencing psychosis.

Reality testing means helping the patient check their internal private experience against the external shared world.

So how does a nurse actually do that in practice?

If a patient turns to you and says, do you hear those voices?

They're screaming at me.

The nurse provides a gentle reality check.

You say, I know the voices are very real to you, but I don't hear any voices.

I just hear the air conditioner humming.

So you're not arguing with them.

You're not saying you're crazy, there are no voices.

Never.

That's invalidating.

You're simply and calmly stating your own reality to give them a reference point.

I believe that you hear them, but I do not.

It's an anchor to shared reality.

Rule number seven, handle hostility therapeutically.

This is the big safety rule.

Patients will get angry.

They will be hostile.

It's a part of the illness for many.

And what does it mean to handle it therapeutically?

It means you don't take it personally.

You don't get into a power struggle.

You don't fight back.

You don't get defensive.

You remain calm.

You set firm, clear limits.

And you try to understand what's driving the hostility.

Is it fear?

Is it pain?

Is it delusional belief?

If you get angry back at them, you've lost control of the therapeutic environment.

And finally, rule number eight, be calm and matter of fact about norms and limits.

Matter of fact.

I love that phrase.

It means neutral, no judgment, no emotion.

Can you give us an example?

Sure.

If a patient breaks a rule, let's say they're caught smoking in the bathroom.

You don't give them a big moral lecture.

You don't say, I am so disappointed in you.

That's not therapeutic.

So what do you say?

You say calmly and in a matter of fact tone.

Smoking is not allowed in the bathroom.

That's the unit rule.

Please give me the lighter.

You'll have to wait until the next scheduled smoke break to go outside.

It just takes all the emotion and the shame out of it.

It makes the rule just a rule, a feature of the environment, not a personal attack from you.

It provides structure without inducing shame.

The expert commentary in the text sums this section up so well.

It says, psychiatric nursing is more than warm, caring feelings.

This more is based on an understanding of psychopathology.

And that brings us right back to where we started to the new paradigm.

You apply rule number six, reality testing, not just because you're a nice person, but because you understand the pathology of hallucinations.

You apply rule number four, prevent failure, because you understand the pathology of a fragile ego in depression.

It is science applied through your behavior.

Okay, finally, the chapter gives us a visual tool to put all of this into practice.

It's a template called the case plan.

This is the practical roadmap that students will use for their assignments.

The text actually shows a sample form, which is really helpful.

It starts at the header section.

Right, pretty standard stuff.

Patient's name, their official DSM -5 diagnosis, the admission date, and then an assessment section, which is divided into areas of strength and problems.

And I really like that strengths comes first.

Me too.

It immediately aligns with rule number two, strength and self -esteem.

We start from a place of strength.

We build on what the patient already has.

Okay, after the header, we have a section for outcomes.

And this is broken down into short -term goals and long -term goals.

And importantly, there's a column for datement.

Nursing is about results.

We need to be able to track if our plan is actually working.

Then we get to the real meat of it, the planning and intervention section.

The model divides this into three key areas.

This is like the holy trinity of psych nursing interventions.

It really is.

Area number one, psychopharmacology, the medications.

The nurse needs to know what the patient is taking, why they're taking it, the side effects, and the desired effects.

Area number two, milieu management, the environment.

How are we purposefully using the safety, the structure of the rules, and the activities of the unit to help the patient get better?

And the third area.

Area number three,

the nurse -patient relationship.

This is the therapeutic use of self.

This is where you document the counseling, the active listening, the reality testing, the limit setting, all of the direct interactions.

And what's at the very end of the form?

Evaluation and referrals.

This closes the loop.

Do we meet our goals?

If not, why not?

And where does the patient go from here?

What's the discharge plan?

It's a really comprehensive system.

It really does.

Put it all together, just like the unit title says.

It does.

It takes this huge abstract concept of mental illness and turns it into a manageable, organized, actionable plan of care.

Well, we have covered a lot of ground today.

I mean, we've gone from the yawn of the old paradigm all the way to the high stakes reality of the new one.

We really have.

We've looked at that staggering 25 % prevalence rate, the gender splits and diagnoses, the big move from the multi -axial system to a more holistic diagnosis.

We talked about the interplay of nature and nurture, and of course, those eight golden rules of management.

It's a dense chapter, but you can see how it lays the foundation for everything else that's gonna come in the book.

You absolutely have to have this before you can move on to specific disorders.

So as we wrap up here, what's the final thought?

What's the one thing we should leave our listeners with from chapter 23?

I wanna go back to that feeling of discouragement in the Norms notes,

that feeling that comes from hearing that mental illness is actually on the rise.

It can feel really overwhelming, almost hopeless.

It can.

But the text gives us the answer.

It gives us the weapon to fight back.

And that weapon is understanding.

I'm gonna quote the book one last time.

A psychiatric nurse can no more effectively plan care without an understanding of psychopathology than a med -surg nurse can without an understanding of pathophysiology.

Knowledge is power.

Knowledge is the tool.

It's the only tool we have.

If you wanna push back against that rising tide of mental illness, you have to understand it.

That's why you're in nursing school.

That's why you're reading this book.

That's why you're listening to this deep dive.

That is very well said.

To all the nursing students out there listening, you are entering a tough field, but it is such a vital one.

Take these tools, the DSM, the definitions, the eight rules, and use them well.

Caring is where you start, but understanding is how you truly make a difference.

Exactly.

Thank you so much for joining us for this deep dive into chapter 23.

We really hope this helps you ace that exam, and more importantly, helps you help your patients.

A warm thank you from the last minute lecture team.

Goodbye, everyone.

See you next time.